Heart failure (HF) affects over 6.5 million adults in the US and carries a mortality of approximately 50% at 5 years after diagnosis. HF is the most common reason for hospitalization among patients age ≥65 years nationally and also leads hospitalizations among cardiovascular diseases in the Duke University Health System (DUHS). HF hospitalizations are not only associated with high mortality and high rates of readmission, but also substantial impairments in patient-reported quality of life and healthcare expenditure.
Multiple evidenced-based therapies substantially increase survival and quality of life, and decrease hospitalization rates among patients with HF with reduced ejection fraction (HFrEF; ejection fraction ≤40%). However, major gaps in medication use and associated adverse outcomes exist in clinical practice. Several patient-level domains may contribute to the quality of care for individuals with HFrEF:
- Medication adherence and associated barriers directly contribute to the progression of HFrEF morbidity, HF related hospitalizations, and high mortality rate;
- Worse dietary adherence to balanced caloric intake (as well as sodium and fluid restriction) is associated with worse quality of life and HF readmissions;
- Early rehabilitation and tailored physical exercise have been shown to improve physical function in HF;
- Mental stress, disparities of care (including those related to social determinants of health) and behavioral/lifestyle factors are associated with all-cause mortality in HF; and
- Management of comorbid conditions (i.e. chronic kidney disease, diabetes, etc.) are associated with HF-related outcomes. What is needed are comprehensive approaches that address these domains that may potentially serve as therapeutic areas of personalized heart failure care.
The Duke Center for Personalized Health Care proposes an innovative telehealth group visit care model for individuals with HFrEF that address these factors for long-term health improvements and disease management. This research will evaluate the efficacy of a 16-week virtual, Personal Health Planning (PHP) HF Program (n=10). This proposal is innovative and clinically important as it aims to assess barriers towards heart failure care while emphasizing patient-centered care.
To assess the feasibility of acquiring patient-centered data on medication adherence, dietary adherence, rehabilitation and physical exercise, mental stress and lifestyle factors, and management of comorbidities through a virtually-based PHP-HF program for patients with heart failure with reduced ejection fraction (HFrEF).
We hypothesize that this research will address a critical need in the care of patients with HFrEF and could lead to new sustainable, lifestyle-based prevention and disease management strategies that are standard guideline-based care as described in the 2022 American Heart Association / American College of Cardiology / Heart Failure Society of America Guidelines. Results of this pilot study will inform clinical trials and programs for personalized HF care and programs towards reducing disparities in HFrEF care.